Young mothers and public health nurses will forge close relationships in a new program in London and Middlesex County

Having a baby at 16 wasn’t going to stop Michelle Kirk from finishing her education. She started back to classes when her daughter was still an infant.

But it seemed the day care was calling her out of school every other day for one thing or another — a high fever, teething pain, a bad cold — and Kirk couldn’t keep up. She says she was living in fear that child welfare authorities would decide she couldn’t take proper care of her baby and take the child away. She dropped school to stay home with her daughter. She’d return when life settled down, she thought.

“And that’s where my school ends: two credits short of Grade 10,” says Kirk, who now at 43 is still on welfare and helping to take care of one of her grandchildren. “I’m still living in poverty. My focus is on getting the child I’m raising now out of the system.”

As a teen mom, Kirk had more urgent worries than school. She’d never paid a bill before she and her newborn moved into an apartment, with rent that took up more than two thirds of her Mother’s Allowance income. She ended up in an abusive relationship with a man but was afraid to leave thinking she’d never find anyone else who’d want her with her kids.

Kirk says she was afraid to ask for help. Afraid she’d be deemed a bad mom and her daughter — and later the other two kids she had before she was 20 — would be taken from her.

“That’s a big fear you have when you’re a young mom. You worry if you tell someone you’re having difficulty, they’re going to take your kids ... You need so much help — any new mom needs help — but you’re afraid to ask because you know you have people judging and scrutinizing you everywhere.

“You get postpartum (depression). Even the richest person in the world can have those feelings, but when I was young, I was convinced they were wrong,” Kirk recalls.

“I remember (my daughter would) cough and I was worried, I didn’t know what to do,” she says. “I didn’t know what medicines were OK for a baby, I didn’t know anything.”

Finally her fear for her child’s health took over the fear of losing her and Kirk called the Children’s Aid Society and asked for an appointment with a public health nurse.

During her visits — over a six-month period — the nurse would bring formula, baby medicine samples, advice and comfort. But there was a downside.

“I became a person of interest with (child welfare authorities),” Kirk says. “All I wanted was someone who knew the answers to my questions. Then they turned it to ‘She doesn’t know what she’s doing. She’s a bad parent,’” Kirk says.

When the visits ran out Kirk wanted the nurse to come back. But she wouldn’t ask. “If I asked for (a nurse) again, I would have been scrutinized even more,” she says.

“But I wish I could have. I’ve never met a public health nurse who judged a mom. They help so much. If any young mom could only get one thing from society, from the government, it should be a nurse.”

London’s medical officer of health Dr. Chris Mackie agrees. It’s why four public health nurses at the Middlesex-London Health Unit are preparing to be part of a program that will pair them with pregnant teens and young women for the first two years of their babies’ lives.

For years, Mackie has been pushing the province to adopt the nurse-family partnership program that partners public health nurses with new moms for intense relationships that include 50 visits between the time the mom is 20 weeks pregnant and the child’s second birthday. The American-based program operates in 40 states and has been rolled out in England and Australia.

Mackie and other supporters say the program is proven to break the intergenerational cycle of poverty.

“It really transforms the lives of the mother and the child,” Mackie says. “Babies are not easy. You are giving parents the tools they need to respond to a baby. The nurses are a trusted provider, they’re not a case worker who’s going to take the child away.”

Decades’ worth of studies have found moms who participated in the nurse-family partnership in the U.S. are more likely to access resources, build stronger support networks, return to school and get better work — taking themselves and their babies out of poverty, Mackie says.

Young moms-to-be were chosen randomly based on a lottery and their progress was followed along with those who weren’t in the program for 40 years.

Children whose mothers were involved in the program were less likely to be exposed to second-hand smoke, less likely to be abused and less likely to have criminal records as adults. They were more likely to be born at a healthy birth weight, graduate high school and get a job.

“Every outcome you’d want for the child is better,” Mackie says. “We’re not putting Band-Aids on here, we’re not treating colds. This is breaking the cycle of poverty.”

In 2009, as associate medical officer of health in Hamilton, Mackie pushed the province to pilot a feasibility study. The province of B.C. has committed $23 million to a nurse-family partnership trial in that province, and health units across Ontario are waiting for results, he said.

The Ontario government spends about $90 million annually to fund a program called Healthy Babies, Healthy Children that gives families considered “at risk” of living in poverty more access to public health resources, including at-home nurse visits.

Anticipating positive findings from the B.C. study, Mackie applied to the poverty reduction fund that last year agreed to commit $350,000 for the development of a Canadian education model, including curriculum and a plan to implement the program.

The education model is being developed by Susan Jack, a professor at McMaster University, and is being tested in three communities: London and Middlesex County, Toronto and York.

Susan Jack

In London-Middlesex, that means four nurses will be devoted to the program beginning next spring.

Having seen up close the affect of poverty on their clients, the nurses are looking forward to developing more intense relationships, said public health nurse Jody Shepherd, who works with young moms.

“They are faced with decisions they have to make (such as) ‘How am I going to feed my child tomorrow? Am I going to choose that or am I going to go to a doctor’s appointment with my last $5?’ They don’t have money to even purchase a bus ticket to get them to a place, like a food bank or meal program or a friend’s house who might be offering them dinner,” she says.

Shepherd says “99 per cent” of the 30 families she works with are struggling with poverty in “extreme situations.

“We hear a lot of stories about trust, different barriers that stop them from accessing services. They feel judged if they go to the food bank, judged if they ask their family doctor for a free sample formula,” she says. The nurses are “very aware of how poverty affects people,” and will work on building a trust relationship so the families are open to help.

“So they will come to us and say, ‘I don’t have any food for tomorrow’ instead of hiding it from me.”

The real focus is on “mom’s goals,” Jack says.

“This is why it is a poverty reduction strategy. It is focused on helping moms become self-sufficient. The nurses are doing everything to support moms to be independent and set goals, how to solve problems and reach out to the right person.”

And when it works? “It takes two generations — mom and baby — out of poverty,” Jack says.

Told about the program last week, Michelle Kirk welcomed the news.

“If I could’ve had a health nurse for two years, without being called a bad mother, it would’ve helped me a lot,” she says. “I would’ve known what to do about the teething. I know I would’ve finished my education.”

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Public health nurse visits

Now: A first-time mom is eligible to have a home visit or phone call from a public health nurse after the birth. Young moms deemed to be at risk of poverty are eligible to take part in the Healthy Baby, Healthy Children program that means they can access more home visits from the nurse if they request them.

Nurse-family partnership: Moms-to-be are referred to the program by a health professional or friend. When the expectant mom is 20 weeks pregnant, the visits are weekly and then biweekly. Weekly visits resume after the baby is born. Visits eventually are scaled back to every two weeks and then to once a month in the three months before the baby turns two. In London, four public health nurses will be devoted to the program and each could have a caseload of 20 families.

Who’s eligible: First-time moms younger than 24 and deemed to be low income or living in poverty.

According to the most recent statistics, 5.2 per cent of babies born in London-Middlesex have teen moms, slightly higher than the provincial average. Twenty per cent of babies born in the area have moms younger than 24, also slightly higher than the provincial average.

Mothers who are teens or aged 35 and older tend to experience more problems with pregnancy, delivery and various birth outcomes, such as low birth weight, pre-term birth, and neonatal mortality. Teen mothers are more likely to be in a disadvantaged social environment.